|
HC RH BLOOD GROUP
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.83
|
| Rate for Payer: Blue Shield of California Commercial |
$24.02
|
| Rate for Payer: Blue Shield of California EPN |
$19.27
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.42
|
| Rate for Payer: Heritage Provider Network Senior |
$72.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
IP
|
$14,419.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,609.84 |
| Max. Negotiated Rate |
$10,814.25 |
| Rate for Payer: Adventist Health Commercial |
$2,883.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,285.84
|
| Rate for Payer: Cash Price |
$6,488.55
|
| Rate for Payer: Cash Price |
$6,488.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,609.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,604.75
|
| Rate for Payer: Multiplan Commercial |
$10,814.25
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
|
OP
|
$14,419.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,609.84 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$2,883.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,910.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$6,488.55
|
| Rate for Payer: Cash Price |
$6,488.55
|
| Rate for Payer: Cash Price |
$6,488.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,507.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,169.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,925.36
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,922.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,609.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,795.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,604.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$10,814.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$13,844.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906811403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,505.76 |
| Max. Negotiated Rate |
$10,383.00 |
| Rate for Payer: Adventist Health Commercial |
$2,768.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,915.54
|
| Rate for Payer: Cash Price |
$6,229.80
|
| Rate for Payer: Cash Price |
$6,229.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,505.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,461.00
|
| Rate for Payer: Multiplan Commercial |
$10,383.00
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$13,844.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906811403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,505.76 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$2,768.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,555.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$6,229.80
|
| Rate for Payer: Cash Price |
$6,229.80
|
| Rate for Payer: Cash Price |
$6,229.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,167.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,169.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,569.44
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,922.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,505.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,795.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,461.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$10,383.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
IP
|
$17,659.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,196.28 |
| Max. Negotiated Rate |
$13,244.25 |
| Rate for Payer: Adventist Health Commercial |
$3,531.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,372.40
|
| Rate for Payer: Cash Price |
$7,946.55
|
| Rate for Payer: Cash Price |
$7,946.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,196.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,414.75
|
| Rate for Payer: Multiplan Commercial |
$13,244.25
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
|
OP
|
$17,659.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,196.28 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$3,531.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,913.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$7,946.55
|
| Rate for Payer: Cash Price |
$7,946.55
|
| Rate for Payer: Cash Price |
$7,946.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,418.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,169.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,930.92
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,922.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,196.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,795.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,414.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$13,244.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$12,559.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,273.18 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$2,511.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,761.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$5,651.55
|
| Rate for Payer: Cash Price |
$5,651.55
|
| Rate for Payer: Cash Price |
$5,651.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,409.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,169.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,774.02
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,922.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,273.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,795.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,139.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$9,419.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$12,559.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,273.18 |
| Max. Negotiated Rate |
$9,419.25 |
| Rate for Payer: Adventist Health Commercial |
$2,511.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,088.00
|
| Rate for Payer: Cash Price |
$5,651.55
|
| Rate for Payer: Cash Price |
$5,651.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,273.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,139.75
|
| Rate for Payer: Multiplan Commercial |
$9,419.25
|
|
|
HC RHC & LHC W/WO LV
|
Facility
|
IP
|
$10,577.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,914.44 |
| Max. Negotiated Rate |
$7,932.75 |
| Rate for Payer: Adventist Health Commercial |
$2,115.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,811.59
|
| Rate for Payer: Cash Price |
$4,759.65
|
| Rate for Payer: Cash Price |
$4,759.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,914.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,644.25
|
| Rate for Payer: Multiplan Commercial |
$7,932.75
|
|
|
HC RHC & LHC W/WO LV
|
Facility
|
OP
|
$10,577.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,914.44 |
| Max. Negotiated Rate |
$12,185.00 |
| Rate for Payer: Adventist Health Commercial |
$2,115.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,536.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$4,759.65
|
| Rate for Payer: Cash Price |
$4,759.65
|
| Rate for Payer: Cash Price |
$4,759.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,240.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,169.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,547.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,922.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,914.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,795.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,644.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$7,932.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
900910868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.48
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.09
|
| Rate for Payer: Heritage Provider Network Senior |
$115.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
900910868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.06
|
| Rate for Payer: Blue Shield of California Commercial |
$45.68
|
| Rate for Payer: Blue Shield of California Commercial |
$45.68
|
| Rate for Payer: Blue Shield of California EPN |
$36.64
|
| Rate for Payer: Blue Shield of California EPN |
$36.64
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.90
|
| Rate for Payer: Heritage Provider Network Senior |
$105.23
|
| Rate for Payer: Heritage Provider Network Senior |
$35.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.67
|
| Rate for Payer: TriValley Medical Group Senior |
$5.67
|
| Rate for Payer: TriValley Medical Group Senior |
$5.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
HC RH IMMUNE GLOBULIN
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
900904586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$242.44 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.44
|
| Rate for Payer: Blue Shield of California Commercial |
$84.49
|
| Rate for Payer: Blue Shield of California EPN |
$84.49
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.47
|
| Rate for Payer: Heritage Provider Network Senior |
$100.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$86.80
|
| Rate for Payer: TriValley Medical Group Senior |
$86.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$78.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC RH IMMUNE GLOBULIN
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
900904586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$139.75
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.47
|
| Rate for Payer: Heritage Provider Network Senior |
$100.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$78.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.85
|
|
|
HC RHOGAM IMMUN GLOB 300MCG 1500I
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
910400061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$271.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$329.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.44
|
| Rate for Payer: Blue Shield of California Commercial |
$84.49
|
| Rate for Payer: Blue Shield of California EPN |
$84.49
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$373.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$373.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.26
|
| Rate for Payer: Heritage Provider Network Senior |
$203.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$209.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$307.30
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.60
|
| Rate for Payer: TriValley Medical Group Senior |
$175.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$145.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$373.15
|
| Rate for Payer: Vantage Medical Group Senior |
$373.15
|
|
|
HC RHOGAM IMMUN GLOB 300MCG 1500I
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
910400061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$329.25 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$282.72
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.26
|
| Rate for Payer: Heritage Provider Network Senior |
$203.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$145.35
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: EPIC Health Plan Medicare |
$2.99
|
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.75
|
| Rate for Payer: Blue Shield of California Commercial |
$71.37
|
| Rate for Payer: Blue Shield of California EPN |
$57.10
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.42
|
| Rate for Payer: Heritage Provider Network Senior |
$72.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$55.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.29
|
| Rate for Payer: TriValley Medical Group Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.35
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.65
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.23
|
| Rate for Payer: Heritage Provider Network Senior |
$299.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.65
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.23
|
| Rate for Payer: Heritage Provider Network Senior |
$299.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.87 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$209.95
|
| Rate for Payer: Blue Shield of California EPN |
$167.08
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$287.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.23
|
| Rate for Payer: Heritage Provider Network Senior |
$299.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$210.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$265.20
|
| Rate for Payer: TriValley Medical Group Senior |
$265.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$273.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.09
|
| Rate for Payer: Blue Shield of California Commercial |
$31.73
|
| Rate for Payer: Blue Shield of California EPN |
$25.51
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$287.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$273.60
|
| Rate for Payer: Heritage Provider Network Senior |
$273.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$210.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.46
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC RIBOPIGG
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913708
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC RIBOPIGG
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913708
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.17
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
